Special thanks to babydoc_vic, fairnymph, forgotten, johnboy, MezZedUp and Negro-kitty

Bluelight has operated continuously since October 1999. During this time, many people have learned everything they know about drugs (and in particular MDMA) from our website. FAQs have been written but some material has been covered in depth while other information has been overlooked. This is forgivable because of the time and effort required to prepare an “essential guide” to MDMA. Even this FAQ, which is over 10000 words long and growing, cannot provide answers to every question. We are optimistic that this guide will provide a way for people to learn the basics about MDMA. Harm reduction is encouraged wherever possible, but hopefully the simple facts will allow people to make more informed decisions about what they put in their body.

In the past, FAQs sometimes were ignored because they were too disjointed or too tedious to read. This guide is organized to give answers in a succinct and organized manner that does not sacrifice accuracy. The correct terminology is used throughout the guide but slang terms are mentioned at least once to allow for context. Citations are included wherever possible and the reader is free to explore certain topics more in depth. Attempts have been made to clearly distinguish between specific facts, generally accepted information, and speculation. For most people who are new to MDMA, it would be a good use of your time to sit down and spend one hour reading the entire guide. If you are in a hurry, this guide is divided into different sections and you can use the table of contents to go directly to the topic you want.

A. What is MDMA?
MDMA is 3,4 Methlynedioxymethamphetamine, commonly known as Ecstasy. Ecstasy is the street name for MDMA, and any drug being sold as MDMA could be called Ecstasy. This document will deal primarily with the chemical MDMA, and secondarily with the phenomenon of the street drug Ecstasy.

B. What is MDMA’s method of action? (How does it work?)
MDMA primarily causes an increase in the concentrations of three neurotransmitters. They are serotonin (5HT), norepinephrine (NE), and dopamine (DA). The effects sought by most MDMA users result from the massive increase in the presence of 5HT in the certain synapses.

The two leading theories for how this happens are:
1. MDMA enters the axon terminal via the 5-HT reuptake transporters, and then prompts vesicles to flood the synapse with serotonin.
2. MDMA causes the 5-HT reuptake transporters to work in reverse, simultaneously stopping reuptake and dumping serotonin into the synapse.

Regardless of how the serotonin gets there, it then binds with 5HT receptors and causes the effects that it does.

C. How much should I take?
MDMA is commonly sold in pill form, and it is difficult to know how much of the drug it actually contains. From this Erowid page:

Trying to calculate dosages from tablets containing unknown quantities of MDMA can be difficult, but a good quality tablet of street ecstasy generally contains an average of between 75 and 100 mg MDMA.

The studies done by Dr. Shuglin indicate that 100-120mg will work for almost anyone, although Erowid claims that some people may require upwards of 200mg in order to have a full-blown MDMA experience.

Most beginners would be best off starting with a dose in the 100mg range (ie: a single pill).

A. MDMA Powder
In his book PIHKAL, Dr. Alexander Shulgin describes MDMA as a "fine, white crystal" but mentions that various factors can have an effect on the form it takes when it is made. An image of MDMA powder can be viewed at this Erowid page .

MDMA powder is sometimes referred to as "molly" which is short for molecule.

B. Capsules
Occasionally, MDMA powder is measured, placed in gelatine capsules and sold without being pressed into a pill. The powder in the capsules may be cut or uncut.

To see global reports on the contents of pills and people's reactions to them, please visit pillreports.com.

Pills contain a significant amount of binders and fillers in addition to any active substance(s) they may contain. Weighing a pill will not give an accurate indication of how much of an active substance it contains.

1. Brands
Because pills appear in so many variations, they are often given a "brand name" based on their colour, logo, etc. For instance, a pill may be referred to as a "white Euro." Many people attempt to judge a pill by its brand name, rather than using a testing kit. Making a judgement based on brand names is not a reliable method for determining whether a pill is safe to take.

However, this can be an effective way to get the word out about a dangerous pill that contains toxic adulterants or simply isn't MDMA.; since copycats of bad pills are rarely made.

1.1 Stamps or Logos
The presses that manufactures use to make the powder MDMA into a pill often have a stamp inside that places a logo on each pill as it is pressed. Often these logos are cartoons, or the logos and trademarks of well known corporations. A pill that was popular for a long time was called the "Mitsubishi" and had a picture of Mitsubishi Motors logo stamped on it.

1.2 Bevelled Edge
Some pills are pressed with a stamp that places a bevel on the edge. This just means there is an indented ring around the edge of the pill.

1.3 Domed
Pills can be domed on neither, either or both sides.

1.4 Scored
It is not uncommon for a pill to have a break line down the middle of one or both sides. Usually the score is on the side opposite the logo. Sometimes the score will get thicker towards the middle of the pill. This is referred to as a "cat's eye". It is not unheard of for a pill to have a double-score (a cross) on either or both sides.

2. Copycats
When a pill of a specific brand begins to be sold on the market, other pill manufacturers will often begin to press pills that appear similar or identical. This is done especially if the original pill gains a reputation of being potent or of high quality. These copycats can contain no drug, a drug other than MDMA, a combination of drugs (sometimes dangerous combinations), or poor quality MDMA. Copycats are the reason that even brands of high repute should not be trusted, and always tested.

3. Double/Triple Stack
Ecstasy users and dealers sometimes refer to a pill as double or triple stacked in order to make it sound like it is especially good. While this is supposed to mean that a pill is twice or three times the thickness of an "average" ecstasy pill (and therefore more potent), it actually means nothing. First, there is no such thing as an "average" sized ecstasy pill. They vary widely in size. Second, a pill's size has little to do with how much MDMA it contains, as the majority of most pills size is made up of various binders and fillers. A quick search on ecstasydata.org would turn up many pills of the same size with different contents, or of different sizes, but with the same contents.

Note – Many of these adulterants illustrate the dangers involved when taking multiple pills with unknown contents. While a single dose may just result in a bad trip, multiple/combined doses can result in serious and possibly fatal health complications.

All of these adulterants are potentially dangerous in their own right. The main purpose of this section is to give you an idea of how to recognise when you have taken a bad pill and provide the most common adverse effects of the given adulterants. For more information on any given adulterant, start by checking other Bluelight FAQs, Erowid or Lycaeum.Bluelight FAQsErowidLycaeum

The Marquis, Mandelin, and Mecke reagents are all capable of distinguishing between MD__ and other substances, thus saving you the hassle of having to worry so much about this section. All of these kits are discreetly and internationally available from EZ Test.

A. MDA/MDE
MDA and MDE seem to produce effects that are very similar to MDMA. Many people report MDA to be “speedier” and MDE to de “dopier” than MDMA. Erowid indicates that relative to MDMA, MDE requires a slightly larger dose and MDA is effective in a slightly smaller dose. Simon’s reagent will discriminate between MDA and MDMA.Bluelight MDA FAQErowid MDA VaultErowid MDE Vault

B. Amphetamine, Methamphetamine
(Meth)Amphetamine will produce stimulatory effects that are noticeably different from MDMA. Large oral doses of methamphetamine may produce an intense empathy (and other “loved up” feelings) very similar to that of MDMA. CNS and cardiopulmonary excitement will probably be more noticeable. Higher doses of (meth)amphetamine can produce uncomfortable skittishness, elevated vitals, irritability and nausea.Erowid Amphetamine VaultErowid Methamphetamine Vault

C. Ephedrine
Ephedrine will produce stimulant effects that are not as intense as amphetamines, but are greater than those of caffeine. Ephedrine alone will not produce auditory or visual hallucinations. High doses of ephedrine have caused anxiety, uncomfortable hyperactivity and hyperthermia.Erowid Ephedrine Vault

D. Caffeine
Caffeine-tainted pills will produce some stimulatory effects, but will not be hallucinogenic or empathogenic (“loved up). Depending on your tolerance and recent consumption, unpleasant effects from caffeine may be felt at doses as low as 50mg.Erowid Caffeine Vault

E. PMA
PMA is an amphetamine-derived stimulant. At low doses, the effects of PMA may feel very similar to the initial effects of MDMA, producing a stimulatory feeling and mild visual effects. However, doses of 60-80mg have been associated with dangerous increases in heart rate, blood pressure, and body temperature.Bluelight PMA FAQErowid PMA Vault

F. AMT
AMT is a chemical that can produce effects which may be difficult to distinguish from MDMA, including the empathogenic effects and jaw clenching. Many trip reports have said that AMT produces a “like rolling” experience.

AMT’s effects are distinguished from MDMA by stronger visuals and a more delayed onset, rise and peak. AMT is effective in much smaller doses than MDMA. Lycaeum and Erowid both peg effective doses as being around 15mg, but there are several trip reports claiming doses of 80mg or more.Erowid AMT Vault

G. 2CB
Straight from Erowid: “The effects of 2CB have been described as a cross between the effects of LSD and MDMA, but that it is nothing like a combination of the two. It is mildly psychedelic, much less mind-expanding or dissociative than mushrooms or LSD, but much less directed than MDMA.” Basically, distinguishing 2CB from MDMA is not difficult.

Also of note is that 2CB’s onset and rise to peak are more drawn out than MDMA; and that 2CB is effective in much smaller doses (10-20mg). In addition to health risks, high doses of 2CB may provide a very unpleasant psychedelic experience.Erowid 2CB Vault

H. DXM
DXM became a popular adulterant in pills because it is legal, sometimes produces effect that a newcomer could deem “Ecstasy-like,” and produces a result with the Marquis reagent that can be confused with MD__. However, oral DXM doses are much greater than those for MDMA. At higher doses, DXM can produce hyperthermia, nausea, vomiting, and unpleasant hallucinations.Bluelight DXM FAQErowid DXM Vault

I. 5-MEO-DIPT
5-MEO-DiPT has been described as a mildly psychedelic chemical that has a penchant for inducing gastrointestinal distress. Although it is being placed on Schedule 1 in the US, its availability in other countries means that DEA scheduling will not make this a less common adulterant.Erowid 5-MeO-DiPT Vault

J. Ketamine
Ketamine is a dissociative anaesthetic. Large enough oral doses can lead to a K-hole, but the amount required (350+mgs) makes this somewhat unlikely. More likely is that the user will experience an unpleasant disconnected and confused sensation. Perhaps the best non-health reason to be concerned about ketamine is that is produces an effect that is very unlike MDMA.Bluelight’s Ketamine Dangers FAQErowid Ketamine Vault

Related MythsNote – Sometimes people send "bogus" pills to analytical testers. Basically someone will add an adulterant to press up a single bogus pill with the intention of creating or furthering a myth (sort of like people who put razor blades or needles in Halloween candy).

1. Ecstasy contains heroin
Status: Basically a myth
There have only been one or two pills that tested positive for heroin. A search on ecstasydata.org would confirm this. If someone says they felt ‘smacky’, and blames this on heroin in the pill, they are mistaken. The effects were caused by another drug, possibly ketamine or MDE.

2. The colour/appearance of a pill is indicative of its contents.
Status: Untrue
The colour/appearance of the pill means absolutely nothing. A quick search on ecstasydata.org would turn up many pills of different appearances with the same contents; or with the same appearance, but different contents.

3. Ecstasy contains mescaline
Status: Untrue
No pills have ever been tested and shown to contain mescaline. A search on ecstasydata.org would confirm this.

Mescaline is incredibly hard to get hold of – there is absolutely no way that someone would waste it by selling it as Ecstasy. If someone had mescaline, they would sell it to people who wanted to buy mescaline. Furthermore, an active dose of mescaline would not fit in a pill.

4. Ecstasy contains LSD
Status: Untrue
A search on ecstasydata.org returns no hits for LSD. This suggests that, if LSD is ever found in pills, it is found very rarely. Hallucinations are possible on high doses of MDMA. However, major hallucinations are more likely to be due to the presence of some adulterant in the pill – MDA is a strong possibility.

5. Pills contain crushed glass
Status: Untrue
Source: various, including Time Out and Mix Mag (UK magazines).
No pills have ever been tested and shown to contain glass. A search on ecstasydata.org would confirm this. When the root source for this claim was tracked down, it turned out to be a dodgy and self proclaimed manufacturer who produced zero evidence to support his claim.

6. Ecstasy is a mixture of heroin and cocaine
Status: Untrue
True Ecstasy is MDMA. It’s a completely separate chemical; it has nothing to do with either heroin or cocaine either chemically or in its effects. Pills sold as Ecstasy may contain substances which aren’t MDMA. PMA, ketamine, DXM, caffeine, speed, MDA, and MDEA are all found in pills sold as Ecstasy. Heroin and cocaine are almost never found in pills sold as Ecstasy, and have never been found in the same pill. See ecstasydata.org for more.

7. Ecstasy contains rat poison
Status : Almost a myth
Source : Various, including Time Out and Mixmag.
One pill in Holland was tested and found to contain rat poison, although this was probably a result of contamination. Reports that large numbers of pills have been found with rat poison in them are a myth. The root source for this myth was the same as for the crushed glass myth. See this thread for more.

Caution - Some time ago, the absorption rates for various methods of MDMA administration were published on Bluelight. They went along the lines of:
Oral = 40-60%
Nasal = 60-70%
Rectal = 80-90%

Since the original posting, these figures have been quoted as gospel on Bluelight and other reputable sites.

These figures are inaccurate. Diligent searching babydoc_vic, Catch-22, fairnymph, and Simon revealed these numbers to be almost total fabrications and the work of another Bluelighter’s imagination.

A. Oral
This is the most commonly used method and involves placing the pill in your mouth and swallowing. Oral administration is the safest method of consumption, as the body was designed to consume nutrients orally and has some natural filters in place (ie. Liver, GI tract, etc.)

Oral Variant - Bombing or Parachuting
Bombing/parachuting a pill means crushing a pill into powder and placing it in a small amount of tissue paper or a cigarette paper before swallowing. Because the pill is already broken up, stomach acids wont have to break the pill down so the effects begin more quickly and sometimes more intensely. A pill that has been broken down into powder can also be placed in a capsule for similar effect.

B. Sublingual
Sublingual administration involves placing the pill beneath your tongue and leaving it there as it dissolves. Sublingual administration is sometimes preferred because the drug will initially bypass your digestive system. By denying your body its customary “first pass” metabolism, the effects will be stronger. Due to the nasty taste this may leave in your mouth, most people seeking the effects of sublingual administration will opt for rectal administration (plugging).

C. Plugging
Plugging is rectal administration, or putting it up your bum.

Plugging is more effective than swallowing or snorting, because the inside of the anus is lined with a thin membrane. The drug is quickly absorbed through the membrane directly into the bloodstream.

There are two ways to plug: a pill can be crushed and placed in a capsule or plugged as it is. Powder in a capsule usually absorbs more quickly as pills can be hard pressed and not break down as easily.

Most users only find plugging slightly uncomfortable. Once inside the anus, the pill should slide up easily. It will be less effective if it doesn't go as far as the second knuckle on the index finger. Users should go to the toilet before hand. Plugging may cause an urge to use the bathroom. It needs to be held until the pill has taken effect. Placing a condom over the finger is a very effective way of plugging as the lube from the condom helps and it's also more hygienic.

D. Insufflation (Snorting or Railing)
This is sniffing the drug. The pill is first crushed into a very fine powder, and then cut into lines. The size of the lines will vary depending on how the user wants to do it. When an entire pill is being snorted, it is generally cut into several small lines, and they are alternated between nostrils. This aids absorption, and helps prevent the burning sensation from becoming too severe

It is common to use rolled up paper money for snorting, although any tube which fits in your nose and is fairly short will do (e.g. a bit of a straw). Please know that sharing snorting devices carries the risk of transmitting Hepatitis C. This method has a better absorption rate than swallowing, with a quicker come-up and more intense peak, but it does not last as long.

E. Injecting
Injected MDMA may provide an overwhelming experience. More importantly, there is much greater risk involved as all forms of built in protection that your body has have been bypassed. You have kidneys and a liver for a reason: to protect you from harmful substances. Never consider injecting anything unless you are sure of its content. Also, injecting may increase the likelihood of neurotoxicity.

WARNING: DO NOT inject crushed up pills unless you have used a pill filter. Straining them through anything else will not remove binders and fillers. If you inject binders and fillers blood clots and infections could result. An increasing amount of people are having arms and legs amputated because they have injected pills without properly filtering them. If you are considering injecting MDMA, try to use pure powder where possible; but even then take all precautions.

V. Different Stages of Effects
For most people, the MDMA experience is a long slow arc, building up slowly, reaching a plateau, with a long gradual comedown. Other people have nearly instant come-ups and comedowns, peaking almost as soon as the drug takes effect, then suddenly sobering up.

1. Comeup
When someone takes MDMA there is a period of time where he/she gradually comes up. The speed with which this process happens is affected by many variables, including method of ingestion, how the pill was pressed, the user's metabolism, and whether or not the user has eaten.

A come up could start after 15 minutes or it could be over an hour. The user will gradually start to feel the effects spread throughout his/her body. It is not uncommon for people to be nauseous during this time or even vomit.

2. Peak
The peak is when MDMA's effects are at their most intense. For some users this is a long plateau, for others it is a series of "rushes" in which they come up, then back down again.

3. Comedown
As the effects of MDMA wear off, the users will find themselves feeling tired, sore and sometimes grouchy. For some users, there will be an urge to take more. What the user did during their experience, how they took care of their body, and how much they consumed will have some effect on how they comedown.

4. Afterglow
Some users find that for up to several days after an MDMA experience, they feel happy and in a good mood. This is more common in occasional users, and those who have not used more than a few times.

Some people, however, experience a "crash" when they come down from MDMA. Crashing is a term referring to all the negative feelings that some users feel after coming down from the drug. This can include lack of energy, weak or sore muscles, depression, nausea, mental fuzziness and being overly sleepy or unable to sleep. For some users the crash is immediate, and such a dramatic change in mood that it overwhelms them. Such users may find themselves weepy, or frightened.

A. Empathy
One of the main reasons people use MDMA is to experience the empathy it creates. Empathy is the ability to share the feelings of another person. For many users, this creates a feeling of deep bond, or love. Because of its nature as an empathogen, MDMA will often help users deal with problems in their relationships and personal lives, especially in the beginning. This can create an illusion that everything is perfect, even when it isn't.

B. Euphoria
Most users get feelings of extreme happiness, a sense that everything is right in the world, and often feelings of love for everyone around them. The latter is also referred to as being "loved-up."

C. Physical Effects
People feel different things when on MDMA. Some get a tingling, that begins behind their ears and spreads all over their bodies. For others, it is like becoming made of gelatine, they "puddle" wherever they are, utterly relaxed and loose. Most people get stimulated, often feeling bursts of energy racing through their bodies. Because MDMA raises the body's temperature, it is common to feel warm, or even hot and flushed.

For many users, the first few weeks/months of MDMA use feel like the best time in their entire lives. For about the first ten to fifty times, they have a great roll every time, and the after effects are generally negligible. Because most users have an afterglow for a day or two, often they don't connect the negative side effects (like depression) to their use.

Instead, it may seem like life just isn't as good when they aren't rolling. Tuesday through Thursday will crawl by, as they wait for the weekend when they can take more. If they begin to build a tolerance - or get more and more impatient between uses - they don't notice.

Many people say that moderation is the key to enjoying MDMA over long periods of time. The negative side effects tend to be less dramatic if you avoid frequent and/or heavy use. The majority of users, especially those who do not moderate their usage, eventually stop enjoying their rolls as much.

Often, the empathy and euphoria disappear, leaving only the speedy and negative effects. For others, they simply require larger and larger doses, for less effect. Some people find that if they stop using for a period of time, from several months to several years, the "magic" comes back. Many users, however, are never again able to feel the way they once did.

There is no firm data, as we can't cut open human brains to check serotonin levels. By averaging a number of rat and lower primate studies, Emmanuel Sferios came up with two weeks as being the amount of time it takes for serotonin to replenish itself. Many users have agreed that this "feels right" and for a long time it has been accepted as gospel. However, taking MDMA at this rate over a length of time would result in a "loss of magic" for most users and could result in permanent damage.

Most people agree that using MDMA two nights in a row is a very bad idea. Articles on Erowid seem to indicate that one ought to wait at least a week between doses, and that waiting 4-6 weeks may make more sense. In large part, this is to allow your body to return to its natural balance. Also, neurotoxicity seems to increase with larger and more frequent doses.

A. Why do my eyes wiggle (nystagmus)?
The temporary eye wiggling experienced by MDMA users seems to be linked to feelings of nausea. Nystagmus can be brought on by feelings of nausea or motion sickness.

B. Why do I get nauseous or vomit?
MDMA-related nausea has a number of causes:

Inhibited digestion – The more blood your body sends to your muscles to do their work (dancing, running around, etc), the less blood will be sent to your gastrointestinal tract to do its work. This inhibits digestion, meaning that whatever you are eating/drinking is more or less amassing in your stomach.

Dehydration – Dehydration can trigger queasiness, either because your body is in distress or because the dehydration is exasperating already present problems.

Bodily distress – When your body senses that it’s in trouble, digestion quickly falls down the list of autonomic priorities.

Flood of serotonin - The majority of the serotonin receptor sites in your body are located in your digestive system. The flood of serotonin that reaches these sites (5HT3 sites) may cause nausea or vomiting.

C. Why does my jaw clench?
There is a nerve in the jaw called the trigeminal nerve, which is responsible for innervating the jaw. This nerve is especially sensitive to changing levels of (among other things) serotonin.

D. Why do I have trouble urinating?
MDMA promotes the release of anti-diuretic hormone (ADH). ADH is responsible for regulating urination. If more ADH is released, urination will not be as forthcoming. An excellent thread on this from Health Q&A:Urination and Methamphetamines

E. Why do my pupils dilate and my heart race?
MDMA is sympathomimetic, meaning that it stimulates the sympathetic nervous system (think: fight or flight). Two common side effect of this stimulation are pupil dilation and an elevated heart rate. Also consider that if you are dancing or engaged in strenuous activity, this will exacerbate the feeling of heart pounding/racing.

Caution - The treatments listed for all of these conditions are viable for mild symptoms ONLY. For more severe symptoms, call an ambulance. Every condition listed here can cause death if not properly treated. For all conditions, it is important to stay with the victim until they have recovered or medical assistance arrives.

A. Dehydration

Causes – Dehydration is caused by failure to consume enough fluids to replenish those that have been lost. MDMA-related contributing factors include excessive perspiration, hyperthermia, vomiting, and diarrhoea.

Prevention

Drink before you are thirsty - thirst is one of the first indicators of dehydration.

Consume water at a moderate and steady rate – do not pound a bottle all at once or take large gulps.

Continue drinking until fluids have been sufficiently replenished and symptoms cease.

Be sure to not drink too much too quickly. If you become nauseous and vomit, the situation will become much worse.

Treat for hyperthermia as necessary.

B. Hyponatremia (water intoxication)

Defenition – Hyponatremia is the condition of having a low blood sodium concentration. This is bad because osmotic pressure will cause water to enter brain cells, causing swelling. This swelling can become severe enough to cause cerebral haemorrhage and death.

Causes – Excessive fluid intake or rapid loss of sodium. Rapid water intake in combination with excessive perspiration and/or vomiting will hasten the onset of hyponatremia.

Causes – Overheating can be caused by physical activity, environment temperature, or an inability of the body to regulate heat as well as usual. One of the possible side effects of MDMA is cutaneous vasoconstriction – this means that the blood vessels closest to the surface of the body constrict. This seriously diminishes the body’s ability to rid itself of excess heat.

The risk of death is real. Assessing the magnitude of that risk is not easy. At the time of this writing, there was no source that provides a reliable total of the number of deaths for which the root cause was MDMA.

Part of the problem is that MDMA is often taken in combination with other drugs. In such a scenario, one cannot say that MDMA was the cause of death because it was the results of the combination that killed the person.

Another issue is that not everyone makes a clear distinction between MDMA and Ecstasy – this is the main reason that estimates from the likes of DAWN are unreliable. When view with a perspective that includes the plethora of bunk pills that have flooded the market, this lack of clarity makes one question the nature of Ecstasy-related deaths.

Another major note about death statistics is that nobody seems to be able to provide accurate information on the number of deaths or serious incidents had by people who were employing harm reduction techniques.

Nicholas Saunders wrote the following in his book E is for Ecstasy, first published in 1993:

Taking the worst figure of seven deaths in 1991 and assuming there were only 1 million users, the risk of dying from using Ecstasy would have been 7 in a million or 1 in 143,000 per year. If users take an average of 25 Es a year, then the risk of death on each occasion is 7 in 25 million or 1 in 3.6 million.

To put this into perspective, if you take five rides at a fun fair you run a risk of 1 in 3.2 million of being killed through an accident. Some sports are obviously dangerous, such as parachuting which kills 3 in 1000 participants per year. Even skiing in Switzerland is risky - 1 in 500,000 are killed. If you play soccer, every year you run a risk of 1 in 25,000 of being killed. But if you stay at home instead of going out you still aren't safe, since the risk of being killed through an accident at home is 1 in 26,000 a year!

To put the words of Saunders in perspective, it is important to note that patterns of use have changed a great deal since his book was written. For example, copycat manufacturing and people taking multiple pills are two trends that were not nearly as prevalent when his book was written as they are today.

All told, the side effects of MDMA can be lethal. Employing harm reduction techniques will reduce the risk of unhealthy side effects coming to fruition.

Myth: You will die if you take more than five pills in a night
Status: Incorrect
Source: poster on bolt.com
You are putting yourself at greater risk by taking more pills. However, you are still very unlikely to die from taking five pills in a night. This statement is meaningless anyway, as the strength of pills varies so much. There are pills which are tested as containing 20-30mg of MDMA, and others which contain 150mg. So one of the 150mg pills would be as strong as 5 30mg pills.

The LD50 of MDMA is 80mg/kg of bodyweight. (The LD50 is the dose at which half the experimental subjects died). So if you weigh 70kg, you would need to take 5600mg to be in serious danger. This is at least 50 or 60 good pills.

It should be remembered that even one pill can lead to death by dehydration, or overheating, or water intoxication.

Also, higher consumption of MDMA is likely to lead to greater problems with depression or memory loss. It’s more likely that heavy use will lead to these problems, rather than to actual death.

A. Why do I have a loss of appetite?
According to the National Institute of Health (US), serotonin curbs the appetite and plays a large role in the eating disorder anorexia nervosa.
Full article: National Institute of Health

Because Ecstasy floods the brain with serotonin, it is likely that MDMA users will suffer a loss of appetite both during their experience and for up to several days afterwards.

B. Why am I depressed?
Many users report feeling depressed after using MDMA. Often, users of MDMA will find themselves to be depressed beginning on the second day after their experience and lasting up to a week. A small percentage of users report feeling depressed for several weeks afterwards.

Some studies have indicated a link between chronic MDMA use and long-term depression. Serotonin, a chemical in the brain closely tied to mood, floods the brain during MDMA use. Several studies have found that MDMA use results in serotonin depletion.

Low levels of serotonin have been tied to depression.
(http://www.biopsychiatry.com/serotonin.htm )
A paper published by Doctors Finnegan, Ricaurte, Ritchie, Irwin, Peroutka, and Langston in 1988 concluded that ecstasy caused a depletion of serotonin in the brains of rats.

As with studies of MDMA-related memory loss; studies linking MDMA to long-term depression have come under fire from critics who question the methods, motives and meaning of the results.

At present we are unsure as to why most people recover within a week or so. It is possible that the serotonin levels are restored to normal, or that the brain adapts to the lower levels. Many people find the use of a pre or post-load reduces or eliminates the depression.

Myth: Taking MDMA just once makes you depressed; and the only way to feel normal is taking more of it.
Status: Partially true
It’s very unlikely that anyone has had this effect from taking MDMA once. However, many of us have reached this point after taking large amounts over a long time. Abuse can lead you to the point where it seems that the only way to feel normal is to keep taking more. It would take a lot of MDMA abuse to reach this point.

C. Why do I get acne or rashes after using Ecstasy?
There are a couple of possibilities.

The first is that ecstasy users often engage in acne causing behaviour. Dancing produces sweat, which can lead to clogged pores. The menthol vapour rub that many users smear on their face can also cause acne. Many users go to sleep immediately after a night of MDMA use, and do not shower or wash their faces.

The second, more serious possible cause, is what has been labelled "ecstasy pimples". This is an acne-like rash that can appear on some users. There is reason to believe it may be linked to a damaged liver, or a liver deficient in the enzyme that metabolizes MDMA. Dr. Uwe Wollina suggest that high levels of serotonin may enhance blood flow to the face, boosting the activity of glands that produce spots when blocked. He suspects that people who break out in spots after taking ecstasy will be more prone to other negative side-effects.
(MAPS Article ).

The third possibility is that the acne results because of norepinephrine-related stimulated production of sebum, a greasy substance that clogs pores and causes break outs.

D. Why can't I sleep afterwards?
MDMA causes a release of both norepinephrine (NE) and dopamine (DA). The stimulatory effects of many drugs are closely tied to NE and DA concentrations. In this case, the release of NE and DA is largely responsible for the “speedy” effect of MDMA.

MDMA also causes a massive release of serotonin. Among other things, serotonin is a neurotransmitter that regulates your circadian (sleep/wake) rhythm. As serotonin concentration increases, sleepiness decreases. This link has some easily decipherable graphs:http://dubinserver.colorado.edu/prj/...ncircadian.htm

E. Why am I getting these headaches?
Many users complain of headaches either during the MDMA experience or shortly afterwards. There are a number of factors that could be causing them.

First, serotonin may play a role in the cause of migraines. Serotonin releasing/depleting drugs like reserpine can induce a migraine. So it follows that MDMA, which causes the brain to be flooded with serotonin, could cause headaches.

Second, MDMA is a stimulant, and stimulants raise blood pressure. Increased blood pressure is known to cause headaches.

Third, the muscle and jaw tension caused by MDMA's stimulant effects can cause or contribute to a headache.

Fourth, nystagmus could possibly cause a headache, especially if a user was attempting to focus his/her eyes.

Note – Each of these issues could really be a FAQ by themselves. Many other sources have already covered these questions with accuracy and depth. Links are provided those documents; followed by quick summations of the documents referenced.

Neurotoxicity
Neurotoxicity encompasses damage done to the central nervous system as a result of MDMA use. This can manifest itself in several ways, such as impaired thinking, memory loss, long term depression and ‘loss of magic.’

The concerns about neurotoxicity are genuine, and are not strictly scare tactics put forth by anti-drug groups. Much of the reason that neurotoxicity is even under debate within the harm reduction community is because the effects are real; and have been mentioned by real users – not lab rats or government puppets.

Think about it – nobody debates whether there is cocaine or heroin in pills anymore, because we all know that it’s BS. Nobody takes Terrence P Farley seriously, because we know he’s spewing lies. Please don’t gaff this off as just another myth about Ecstasy.

Although we can make some educated guesses; nobody seems to know exactly what causes neurotoxicity, how to combat it, or how quickly it happens. The most reasonable opinion appears to be the such knowledge is obtainable, but that a new study or series of studies will be needed before definitive conclusions can be reached.

A. Memory loss
Damage to certain parts of the brain is known to cause memory loss. There are studies which indicate that MDMA use can cause the requisite amount of damage for memory loss to occur. However, the results are debatable. The methods used in the studies, the motives of the researchers and the significance of the data are all frequently called into question.

Other points of contention are what effects (if any) harm reduction techniques have on memory loss, and whether the loss is permanent.

B. Anxiety, paranoia, insomnia, etc
Anxiety, paranoia, insomnia, headaches, confusion, dizziness and other negative effects have all been reported to accompany MDMA use. These effects seem to be most apparent after the peak positive effects have been reached. Here’s a nice bit from Erowid that goes into greater detail:Short-term Side Effects of MDMA

C. Losing the magic
“Loss of magic” refers to the apparent diminishment of the effects of MDMA with repeated use. Although no formal studies have been conducted, numerous reports from individuals seem to confirm that this is a bona fide side effect. For some people, the effects of MDMA have faded enough to cause them to abstain from use.

For more information on losing the magic, please consult Erowid’s article:MDMA Loss of Magic

Several theories exist about why this happens. One is the loss of novelty. When you do something fun the first few times, it is exciting, and pleasurable. After you have done it too many times, or too often, it can become simply routine, or worse, unpleasant. For instance, many people enjoy a steak once or twice a month. It is something they look forward to. But if they had steak every single night they would quickly become sick of it. Unfortunately, this can't explain the tolerance that appears to develop, nor the fact that some people can never get the good effects to come back.

The other theory that gets a lot of attention is that there might be changes in the brain responsible for this. If this is true, it probably causes other problems like depression, memory loss, etc. For now, the best way to hang on to the magic is to take care of yourself by using moderately.

Related Myths
1. Ecstasy drains your spinal fluid.
Status: Untrue
Source: Oprah among others.
Discussion: A total myth. One of the ways of measuring the effects of MDMA is to take measures of serotonin production. Serotonin is produced in your brain, but also in your spinal fluid. Therefore, researchers have measured serotonin levels in spinal fluid, to determine whether MDMA usage was affecting them. See for example: http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstracthttp://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract
Ecstasy does not actually drain your spinal fluid.

The second misapprehension concerned the fact that MDMA causes some sort of drainage of spinal fluid. This misconception somehow resulted from a misunderstanding of research into the effects of MDMA on levels of the neurotransmitter serotonin, which are accessed through spinal taps. It's the spinal taps that drain the fluid, NOT the MDMA.

It’s also possible that the myth spread because ecstasy users, having danced all night, woke up with sore backs, and the story went around that this was due to spinal fluid loss. Of course, it was just backache from overexertion.

2. Ecstasy burns holes in your brain.
Status: Untrue
Source: Oprah; MTV's Special on Ecstasy, 11/28/2000.
Rebuttal: Rick Doblin, PhD – see http://www.maps.org/media/mtvclarify.html
MTV presented a brain scan of a woman named Lynn Smith, who had consumed a large amount of MDMA. This brain scan was described as showing ‘holes in her brain’, similar to the brain of an elderly woman who had had many strokes. However, the scan actually measures the amount of blood flow in the brain. The ‘holes’ merely demonstrate a lower blood flow in some regions of her brain. These lower figures are relative, not absolute – they are lower relative to her own brain, not to anyone else’s. Not to a “normal” standard. In other words, you could scan anyone’s brain and get the same results, if you wanted to.

Another study, which used more sophisticated techniques to compare MDMA users and non-users, found no significant difference in brain blood flow between the two groups.
More information at the above hyperlink.

3. Ecstasy makes the cells of your brain stem break off and they travel down your spine.
Status: Untrue
Source: Raver who claimed his doctor told him this
No idea where this one came from. There is absolutely no evidence to suggest it is true. See http://www.dancesafe.org/slideshow/ for details of how MDMA affects your brain.

4. Ecstasy makes your brain bleed.
Status: Untrue
Source: Unknown, appeared as a question on Bluelight
No idea who started this rumour. There is absolutely no evidence to suggest it is true. See http://www.dancesafe.org/slideshow/ for details of how MDMA affects your brain.

5. Ecstasy will increase your risk of having a deformed baby
Status: No evidence exists to support this claim.

You should drink water, sports drinks, and juice. At the same time, be careful about drinking too much (which can lead to hyponatremia).

The overheating brought on by MDMA (particularly in combination with vigorous physical activity) requires users to constantly replenish lost fluids while still being wary of not consuming too much water and not enough sodium.

Pre/postloading is usually done during the 24-72 hour period on each side of the roll; and includes one or more of the following:

5HTP – Although not proven to be effective, 5HTP is a precursor to serotonin. 5HTP is available OTC at pharmacies and health stores. Pre/postloading doses usually vary from 100-500mg.

Consumption of 5HTP is both protective and experience-enhancing. For more information, see Bluelight’s 5-HTP FAQ.

Magnesium – Magnesium is a commercially available and natural muscle relaxant. This idea behind using muscle relaxants is to relieve the jaw clenching that can often accompany MDMA use. Preloading doses usually vary from 300-500mg.

Vitamin C – Studies have indicated that Vitamin C can be effective in combating neurotoxicity. Doses usually start at 500mg and go up from there, with 1000-2000mg being a common pre/postloading dose.

Antacids – The combined effects of drugs, drinking (even water) and dancing can seriously upset stomachs. Having a few Tums handy can preserve a good trip and save you a jog to the loo.

Grapefruit Juice – Grapefruit juice inhibits CYP3A4, which is an enzyme in your digestive system that aids in the metabolism of many drugs. By inhibiting CYP3A4, you are essentially making more MDMA available. Although there is some debate as to what exact component(s) of grapefruit juice have this effect, it is accepted that something in there does the job.

L-Tyrosine and DLPA – While some people advocate preloading with L-Tyrosine and/or DLPA, this idea has been discredited. DLPA is a precursor to L-Tyrosine, and L-Tyrosine is a precursor to dopamine. Much of the speculation about MDMA related neurotoxicity centres on dopamine being taken up through serotonin reuptake transporters.

Other Substances – There are a smattering of other preloading tricks recommended by all sorts of people. The ones listed above are the most key and the most proven.

Note – the following touches on four groups that commonly pop up with question marks in ED. Use common sense. If you have a condition that will be exacerbated by taking a [stimulant, hallucinogen, psychedelic amphetamine, enactogen, empathogen, etc], then you probably oughtn’t be taking MDMA.

A. Diabetics
Diabetics can safely use MDMA, but doing so requires a greater degree of caution. As with any stimulant, MDMA will speed up a person’s metabolism - especially when combined with vigorous physical activity. This can cause blood-sugar to plummet to dangerous levels. This is complicated by the fact that the warning signs of low blood-sugar may be masked by or dismissed as the effects of MDMA.

For the same reasons, a person may consume too much food/drink in an effort to keep their speedy metabolism in check. This can result in extremely high blood-sugar levels when the person decides to stop dancing and/or the effects of the drug wear off.

Proper monitoring of blood-sugar/insulin levels, eating/drinking enough (but not too much), and having ready access to emergency treatment measures can help make this a safe experience.

B. Mental Illness
MDMA can exacerbate already present mental illnesses and reduce a person’s ability to recognize and handle their problems. More importantly, MDMA may be dangerous when used in combination with drugs used to treat various mental illnesses, particularly MAOIs.

C. Epileptics
MDMA and other stimulants can increase the likelihood of seizures in people with epilepsy. Also, MDMA may be dangerous when used in combination with drugs used to treat epilepsy.

D. Age (too old/too young)
There is not much research on the effects of MDMA with regard to very old or very young people. In this situation, it seems that common sense ought to prevail. Since few people possess such sense, here are some guidelines, which are purely conjecture:

Persons who have not emerged from puberty should not use MDMA. The term “puberty” is used instead of just “too young” because it is more objective. This is important mainly because so little is known about how MDMA effects growth and maturation. It would seem that the height of such physical and mental growth (adolescence) should be kept free of substances that could adversely alter the outcome.

Expectant mothers should not use MDMA. This follows from pretty much the same reasoning as above.

You are never too old to drop a pill and roll balls (or whatever the hip phrase is). The Shulgins are both more than 70 years old, Saunders was 60 when he died (in a car accident), and Oldroller would certainly agree. It seems that much of the fuss about geriatrics not taking drugs stems from the fact that geriatrics are more likely to have a health condition that would prohibit them from doing so.

Note – Risks always increase when drugs are taken in combination. In particular, you really oughtn’t to be mixing drugs unless you are familiar with each drug separately.

There is also a concern that combinations may cause a user to lose track of how much they have already taken or be encouraged to take more because the effects are skewed or masked.

Avoid taking untested pills in combination with anything. Even though MDMA may be not so dangerous when combined with certain other drugs, you have no assurance that the pill you are taking contains MDMA. It may contain a different substance that is extremely hazardous when taken in combination.

A. DXM
Combining DXM and MDMA can be extremely dangerous. Both DXM and MDMA rely on the same enzyme for metabolism (breakdown in the liver), and if you combine these two drugs, then they compete for the enzyme. As a result, either one or both of the drugs isn't broken down quickly enough, and a toxic build-up of that drug/those drugs occurs. In this particular case, the build-up of DXM/MDMA can lead to SEROTONIN SYNDROME, a very unpleasant set of symptoms than can be fatal. (Kreth K, Kovar K, Schwab M, Zanger UM. Identification of the human cytochromes P450 involved in the oxidative metabolism of "Ecstasy"-related designer drugs. Biochem Pharmacol. 2000 Jun 15;59(12):1563-71.)

In addition, DXM causes an increase in body temperature and when combined with MDMA it can lead to dangerous overheating. Furthermore, DXM contributes to diarrhoea and vomiting. This gastrointestinal purging can be a major contributing factor to hyponatremia. Both overheating and hyponatremia can be fatal. The dissociative effects of DXM might possibly cause a user to be less aware of the fact that bad things are happening to their body.

Avoid this combination by not taking multiple pills unless you have tested them and know the contents of those pills. Also, DXM is an ingredient in many OTC cold medications - check the list of ingredients. DXM will remain active in the body for 4-8 hours. If you have taken cough syrup earlier in the day, be wary of dosing MDMA until the DXM has left your body.

B. Stimulants
The further increase in heart rate, blood pressure, respiration and body temperature caused by other stimulants can make more dangerous when combined with MDMA. It seems that many stimulants also cause an increased production of ADH (anti-diuretic-hormone). If this is true, it is relevant because an increase in ADH contributes to hyponatremia. Also, the combined crash resulting from coming down off of MDMA and [other stimulant] may be exceedingly difficult to bear.

C. Psychedelics
Since the practice of ‘candyflipping’ is relatively new to the mainstream, there is not much literature on it. One study was written by Marty Schechter and published in the European Journal of Pharmacology 341; p.131-134, 1998. Basically, it says that an LSD/MDMA combination is more effective at lower doses than MDMA alone.

Of note is that some psychedelics tend to induce nausea. If vomiting ensues, this may contribute to the onset of hyponatremia.

D. Marijuana
At the time of this posting, there was no published evidence suggesting that this combination is particularly dangerous. Many users report that using marijuana in combination with MDMA intensifies their experience. Also, marijuana is often used when coming down off of a roll.

E. Alcohol
Mixing MDMA with any depressant is dangerous. The increased stress placed on the cardiovascular system can lead to immediate medical problems. The dehydration and nausea that alcohol induces can accelerate the onset of hyperthermia or hyponatremia.

Also, consuming more drugs than you intend to is a particular concern when depressants are mixed with stimulants. The seemingly antagonistic effects that one drug has on the other can lead a user to consume far more than they otherwise would. This can be especially problematic because the drugs will often have different dose/response correlations and different response timetables.

F. Viagra
Due both to some of the temporary side effects of MDMA and the (sometimes) increased sex drive felt by some people, MDMA and Viagra seems to be a logical combination to many. However, this combination puts a tremendous strain on the heart, and may lead to serious problems (read: heart attack).

A. What is a drug test?
The standard drug test is the NIDA-5 (National Institute on Drug Abuse) test where your urine is analyzed for the presence of amphetamines, cocaine, morphine/heroin, PCP and THC (marijuana). There are also blood and hair drug tests, but they are more complicated and expensive (and therefore more rare) than urine testing, so these questions assume that someone is taking the NIDA-5 urine test.

B. Will ecstasy show up on a NIDA-5 urine test?
MDMA (ecstasy) is not one of the substances specifically targeted by the NIDA-5 test, but you can fail a drug test because of your MDMA use. First, MDMA is close enough in chemical structure to cause you to test positive for having used amphetamines. Second, there can also be other drugs in a pill besides MDMA or MDA. Your ecstasy use can definitely cause you to fail a drug test because of these two reasons.

C. How long does ecstasy stay in your system?
It depends on a lot of factors, but on average the half-life of MDMA inside a human body is 8-9 hours. That means within 72 hours, less than 1% of MDMA will be left in your system. Everyone's body is different and there will be some variation.

D. How long should I abstain from ecstasy before taking a drug test?
To be on the safe side, the best advice is to allow at least a week between your MDMA use and taking a drug test. A detectable amount of amphetamines would still be present in your urine for 24-72 hours after a single MDMA use or 72-120 hours after heavy MDMA use. As mentioned earlier, other contaminants might be present in an ecstasy pill. Cocaine is detectable in urine for 48-72 hours after use, while amphetamines are detectable for 48-96 hours and methamphetamines are detectable for 48-96 hours. Ketamine might be detectable in urine after 48-96 hours using specialized tests. DXM is not illegal. 2C-B and research chemicals are unlikely to cause a positive result, but if so they would be on the same time scale as amphetamines. Combining all the different possibilities, waiting a minimum of five days would be reasonable and waiting at least seven days would be very wise.

E. Where can I get other information?
This discussion has focused on providing quick answers about MDMA and drug testing, so those wanting to know more or having questions about other drugs should consult Erowid's Drug Testing Vault for more information.

A. What is sex like on MDMA?
Users often find the physical sensations greatly intensified, especially the kissing and caressing. Most males have difficulty achieving erection, and nearly everyone has a hard time reaching orgasm.

Basically, the time of the month can affect both how high you get and how much damage you can do to yourself. Also, amphetamines can affect the timing of your cycle. If this is a topic of interest for you, please read fairnymph’s FAQ.

C. Why can't I get an erection (or orgasm)?
Excessive serotonin has been linked to erectile dysfunction. This is why people on SSRIs frequently experience trouble with erection/lubrication/orgasm. MDMA has also been implicated in vascular constriction (less blood flow), particularly to the surface of the body – this could also contribute to sexual dysfunction.Vascular Constriction

D. Does MDMA makes you gay?
No. For many users, the normal sense of "personal space" and boundaries disappears. MDMA is a very tactile drug, and human touch feels especially good. Combined with the "loved-up" feeling, it may cause a user to become more "touchy-feely" than they usually would be. The user may hug, kiss, or give and receive massages from a member of the same sex. This has nothing to do with sexuality, and everything to do with feeling good.

There are two reasons why this myth may have started. Firstly, MDMA was first used widely in the gay club scene in the United States, back in the early 1980s. It’s possible that the drug gained a reputation as a ‘gay drug’ from this. Secondly, taking MDMA makes people more open about their emotions and more tactile (enjoying touching others). Some men might be unfamiliar with these emotions or uncomfortable with the feelings of love they experience towards their male friends. This isn’t the same as homosexuality. There’s no evidence at all that taking MDMA can change your sexuality. However, some people who were in denial about feelings of attraction to the same sex might find those feelings brought out while under the influence of the drug.

Related Myths

1. Taking MDMA shrinks your penis or breasts.
Status: Untrue
There's no evidence for this. (Although MDMA and other amphetamines may cause temporary shrinking of the penis, this isn't permanent.)

2. Don’t have sex while you’re rolling, you’ll never enjoy normal sex again.
Status: Myth
Supposedly sex on MDMA is so good that normal sex can never compare. This is false. Many people don’t particularly like sex while on MDMA. Many men find it hard to achieve an erection, and almost everyone has difficulty (or inability) reaching orgasm. Sex for them is much better while sober. Even those who do enjoy the sex do not report feeling dissatisfied with sober sex.

3. MDMA makes you want to have sex with everyone.
Status: Myth
MDMA has been called the ‘love drug’, which has led some people to believe that it is all about sex. It isn’t – it’s called the love drug because it makes you experience strong feelings of love for those around you. It’s love in the emotional sense, not the sexual one. Many people don’t feel any hornier while on MDMA, and many men have trouble getting erections or reaching orgasm.

4. Ecstasy makes you more prone to AIDS.
Status: Untrue
Source: Irish TV ads
There’s no evidence that MDMA makes you more prone to catching HIV/developing AIDS. However, use of Ecstasy has been shown to be correlated with risk-taking behaviours. These include engaging in unsafe sex, which would increase the risk of catching HIV. Of course, there is no suggestion that taking Ecstasy makes you more likely to have unsafe sex – it seems more likely that those who choose to take risks in one area (such as taking drugs) are more likely to take risks in another (such as having unsafe sex). Please, be careful out there.

Klitzman RL, Greenberg JD, Pollack LM, Dolezal C. MDMA ('ecstasy') use, and its association with high risk behaviors, mental health, and other factors among gay/bisexual men in New York City. Drug and Alcohol Dependence 2002 Apr 1; 66(2) p.115-25 http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

A study of risk behaviours among gay men who use MDMA in New York.
MDMA users were found to be younger, less educated, to have had more male partners, more one night stands with men, more visits to bars or clubs and sex clubs or bathhouses, to have unprotected anal sex with a male, to be likely to have been the victim of physical domestic violence.

Study of gay men attending circuit parties, comparing regular drug users with non-users, and seeing which ones were more likely to engage in unsafe sex. Frequent (rather than occasional) use of Ecstasy, Special K, and poppers had an association with unsafe sex at parties.

Mansergh G, Colfax GN, Marks G, Rader M, Guzman R, Buchbinder S. The Circuit Party Men's Health Survey: findings and implications for gay and bisexual men. American Journal of Public Health 2001 Jun; 91(6): http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract
An association was found between use of drugs and sexual risk behavior.

Waldo CR, McFarland W, Katz MH, MacKellar D, Valleroy LA.
Very young gay and bisexual men are at risk for HIV infection: the San Francisco Bay Area Young Men's Survey II. Journal of Acquired Immune Deficiency Syndrome 2000 Jun 1;24(2):168-74 http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract
Studied the risk of HIV infection among very young gay and bisexual men (aged 15-17 years) and their older counterparts (aged 18-22 years). In both age groups, use of amphetamines, ecstasy, and amyl nitrate was associated with unprotected anal intercourse.